Comments on: Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India

Dear Sir,

We would like to congratulate the authors for elaborately reporting dematiaceous fungal keratitis,[1] a lesser documented form in literature. This is one of the largest case series from North India which has reported it.

Although the authors have given an extensive description of the etiology and clinical features, we would like to know about how much was the delay in patient presentation to the authors as it plays an important role in deciding the prognosis and final outcomes. Sengupta et al.[2] reported central location of ulcer to be a statistically related risk factor for analysis of final visual outcome on multivariate analysis. Could the authors find any such factors and whether a univariate and multivariate analysis was performed for the same?

In the reported series, three patients were using topical steroids. We would like to know about how did these patients fare in terms of final visual outcomes, healing and in regards to the surgical management. Also, the treatment protocol mentioned by the authors describes the use of topical natamycin suspension and voriconazole for larger and deeper ulcers.[1] We would like to know if any systemic medication/intra-stromal injections were given for deep seated infections as has been reported by other studies.[2,3,4]

Early surgical intervention before the disease becomes advanced has been recommended by Xie et al.[5] Therapeutic penetrating keratoplasty was performed in four eyes by the authors. We would like to know the indications for surgical intervention and according to the authors what is best time to intervene? What was the graft size used by the authors and also the details about post op medication regimen.

We again congratulate the authors and await their reply eagerly.

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Conflicts of interest

There are no conflicts of interest.